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Results for “Trochlear Nerve Diseases”

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At least 19 recordsLinked to original sources
PubMed2001

Vascular compression as a cause of superior oblique myokymia disclosed by thin-slice magnetic resonance imaging.

PURPOSE: To describe a case of superior oblique myokymia in which thin-slice magnetic resonance imaging (MRI) appeared to show vascular compression of the trochlear nerve. METHODS: A 50-year-old woman presented with episodic monocular oscillopsia. Neuro-ophthalmologic examinations showed intermittent intorsional microtremor of her right eye, diagnosed as right superior oblique myokymia. Thin-slice (1.6 mm) MRI, using spoiled gradient recalled acquisition in the steady state, was employed to examine the trochlear nerve in its course through the ambient cistern. RESULTS: Imaging disclosed a branch of the posterior cerebral artery immediately adjacent to the right trochlear nerve. CONCLUSION: These magnetic resonance findings suggest that a cause of superior oblique myokymia may be vascular compression of the trunk of the trochlear nerve.

Cerebral Arteries↗
PubMed2001

Imaging evaluation of cranial nerves 3, 4, and 6.

Neuropathies of the oculomotor, trochlear, and abducens nerves may present with isolated or complex neurologic findings. An understanding of the anatomy of these cranial nerves as they traverse the brainstem, basilar cisterns, and cavernous sinus on their way to the orbit can assist in localizing the suggested site of pathology and help to focus imaging protocols. Differential diagnostic possibilities for specific anatomic locations are reviewed.

Abducens Nerve↗
PubMed2004

Superior oblique myokymia caused by vascular compression.

A 49-year-old man had left superior oblique myokymia for eight years. Magnetic resonance images with enhanced spoiled gradient recalled acquisition in the steady state (SPGR) and flow imaging using steady acquisition (FIESTA) disclosed a branch of the superior cerebellar artery lying on the root exit zone of the left trochlear nerve. Posterior fossa craniotomy confirmed the imaging findings. A Teflon pad was placed between the compressing artery and the trochlear nerve. The patient's superior oblique myokymia has completely resolved with a one-year follow-up. Only one such case has been previously reported. This is the first report to display the imaging findings.

Cerebral Arteries↗
PubMed2002

Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?

PURPOSE: To review patient outcomes after radiosurgery of nonvestibular schwannomas. MATERIALS AND METHODS: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n = 1), trigeminal (n = 10), jugular foramen region (n = 10), and hypoglossal (n = 2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). RESULTS: Twenty-two of 23 tumors (96%) were either smaller (n = 12) or unchanged in size (n = 10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17%). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. CONCLUSIONS: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves.

Adolescent↗
PubMed2004

Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.

BACKGROUND: Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction. METHODS: Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction. RESULTS: Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries. CONCLUSIONS: Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.

Abducens Nerve Injury↗
PubMed2001

Localization of post-traumatic trochlear nerve palsy associated with hemorrhage at the subarachnoid space by magnetic resonance imaging.

PURPOSE: To report evaluation of traumatic trochlear nerve palsy using head magnetic resonance imaging. DESIGN: Observational case reports. METHODS: We examined two cases involving trochlear nerve palsy after closed head injury. RESULTS: Using a fluid attenuated inversion recovery pulse sequence, MRI showed a high-intensity lesion consistent with subarachnoid hemorrhage at the trochlear nerve area in the ambient cisterns. CONCLUSION: An impact force directed toward the tentorium can be a mechanism of injury in some post-traumatic trochlear nerve palsies. Fluid attenuated inversion recovery pulse sequence is a sensitive method for detection of abnormalities in cases associated with head injury.

Adolescent↗
PubMed2004

[Decompensated strabismus surso-adductorius].

Strabismus surso-adductorius is a frequent unilateral or bilateral eye movement disorder. Its clinical features include eye elevation with concomitant vertical deviation in adduction, an abnormal head posture from which the patient is unaware (head turned and tilted towards the healthy side), a moderate subjective excyclotorsion, and a positive Bielschowsky head tilt test. Despite its anglo-saxon denomination as "congenital fourth nerve palsy", it is not a paretic disorder. Strabismus surso-adductorius differs from fourth nerve palsy both by etiology and by symptoms. A proper diagnosis is important as neuroradiological examination is mandatory in cases of acquired non-traumatic fourth nerve palsy, whereas decompensated strabismus surso-adductorius can be operated on without any further investigations. Early on, the oculomotor disorder is often well compensated and it does manifest at the adult age. Asthenopia and intermittent vertical diplopia appear as the fusional mechanisms fade out. The best surgical technique for strabismus surso-adductorius is an inferior oblique weakening procedure. In severe cases a combined shortening of the superior oblique tendon may be necessary.

Adult↗
PubMed2000

Traumatic trochlear nerve palsy following minor occipital impact--four case reports.

Four patients presented with transient trochlear nerve palsy following occipital impact. The impact was slight in all patients, and neuroimaging found no lesions of the nerve. Three patients had delayed onset. Two patients did not complain of diplopia, but were only aware of blurred vision. In such patients, the head tilting test was useful for diagnosis. Minor occipital impact can cause trochlear nerve palsy, which requires careful neurological examinations to identify.

Adult↗
PubMed2006

A case of multiple cranial nerve palsies as the initial ophthalmic presentation of antiphospholipid syndrome.

PURPOSE: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS). METHODS: Medical records of a 16-year-old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed. RESULTS: A 16-year-old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH20. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS. CONCLUSIONS: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

Abducens Nerve Diseases↗
PubMed1988

Trochlear nerve meningioma in von Recklinghausen's disease.

A trochlear nerve meningioma in a patient with von Recklinghausen's disease is reported. The tumour appeared to have originated from the trochlear nerve itself, having no connection either with the neurinomas present in the adjacent regions, or with the tentorium. Histological examinations revealed that the tumour was a meningotheliomatous meningioma and the trochlear nerve fibres were placed in the periphery of the tumours. It was noteworthy that diplopia was not detected either before or after the resection of the trochlear nerve with the tumour.

Adult↗
PubMed2000

Remission of superior oblique myokymia after microvascular decompression.

Superior oblique myokymia (SOM) is an ocular motility disorder characterized by oscillopsia, vertical or torsional diplopia, sometimes combined with pressure sensation. Although the pathophysiological basis is unclear, isolated case reports have documented its association with intracranial pathological processes. We present a case of SOM associated with a vascular compression of the fourth nerve at the root exit zone. Following microneurosurgical decompression, SOM completely resolved and paralysis of the fourth nerve occurred. This was less disturbing.

Decompression, Surgical↗
PubMed2006

First a third, then a fourth nerve palsy in multiple intracranial aneurysms.

BACKGROUND: Intracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves. METHODS: We report the unusual occurrence of an isolated fourth nerve palsy related to a cavernous carotid aneurysm, angiographically confirmed. The patient already underwent clipping of a ruptured posterior communicating artery aneurysm 17 years earlier, revealed at that time by a third nerve palsy. RESULTS: Endovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy. CONCLUSION: Occurrence of an acquired fourth nerve palsy in a patient with a past history of aneurysm should prompt neurovascular imaging as multiple aneurysms may cause sequential ocular motor palsies.

Aneurysm, Ruptured↗
PubMed1996

The ocular motor nerves.

Recent articles in the scientific literature have described major advances in our understanding of the anatomy and vascular relationships of the three ocular motor nerves (cranial nerves III, IV, and VI) and of the diagnosis and treatment of a variety of pathologic processes that damage these nerves, including ischemia, inflammation, and compression.

Abducens Nerve↗
PubMed2000

Ocular motility review for 1997-1998: part I.

Each year brings new scientific knowledge that builds on itself in a geometric fashion. Ocular motility basic and clinical neurosciences continue to advance with this accelerating pace. The years 1997 through 1998 brought new knowledge to the motility world. This review focuses on the clinical advances within this realm, presented in supranuclear to myopathic organization. Part II of this review will appear in the September 2000 (20:3) issue.

Abducens Nerve↗
PubMed1998

Eye movements: pathophysiology, examination and clinical importance.

The ocular motor system finds, focuses, fixates and follows objects to ensure optimal vision as we move through our environment. To see clearly, images must be held steady on the retina. If images move across the retina at more than a few degrees per second they appear blurred. Thus, one function of eye movements is to hold images of the world steady on the retina, and this is accomplished by the gaze-holding mechanisms--fixation, vestibular and optokinetic. Visual acuity is best at the fovea, and so a second function of eye movements is to change the line of sight so that the image of an object of interest is brought to and held close to this part of the retina. This second group of eye movements, the gaze-shifting mechanisms, comprise saccades, smooth pursuit and vergence. The net result of gaze-holding and gaze-shifting mechanisms working properly together is clear, binocular vision. Conversely, if these movements are not working together, our view of the world becomes compromised by double-vision, blurred vision or oscillopsia, the sensation that the seen environment is jumping. The anatomic substrate for each functional class of eye movements is now well defined. This means that specific abnormalities on the eye movement examination may provide clues to the underlying pathology, and suggest strategies for treatment of a variety of neurological disorders.

Abducens Nerve↗
PubMed2001

Palsies of the third, fourth, and sixth cranial nerves.

Diplopia is one of the most vexing problems to confront a physician. When diplopia is binocular, it commonly results from dysfunction of one or more of the ocular motor nerves. Ocular motor dysfunction may result from injury anywhere along the neuraxis, from the ocular motor nucleus to the myoneural junction. Identifying the location of the lesion is important for determining the etiology and prognosis of third-, fourth-, and sixth-nerve injuries. In this article, an anatomic approach is presented for the diagnosis and treatment of ocular motor nerve lesions. Emphasis is placed on the identification of associated neurologic and ophthalmologic findings that are critical for management of patients with acquired and congenital ocular motor palsies.

Abducens Nerve Diseases↗
PubMed2005

[Atypical ocular myasthenia gravis].

The diagnosis of ocular myasthenia gravis is rarely in doubt in patients with a proper history and typical clinical findings. However, myasthenia gravis can mimick any pupil-sparing eye movement disorder and several diseases may masquerade myasthenia gravis. We review the atypical presentations and differential diagnoses in ocular myasthenia gravis, describing four patients with some of these conditions (4th nerve palsy, near spasm reflex, one-and-a-half syndrome, orbital meningioma). The correct interpretation of the clinical findings associated with appropriate neuro-imaging studies allowed the appropriate diagnosis in these cases.

Adult↗